Concomitant Hypertension and Diabetes: Role of Aortic Stiffness and Glycemic Management

Even with adequate glycemic and blood pressure (BP) control, treated type 2 diabetic hypertensive subjects (DHS) maintain a consistently elevated overall and cardiovascular (CV) risk.^1–4 Increasing evidence shows that when overall and CV mortality rates are calculated exclusively from the hemodynamic factors that affect BP, these parameters do not differ significantly from those of non-DHS.⁵ Evaluation of the interaction term (hypertensive with or without diabetes * hemodynamic factors) indicates that the impact of BP hemodynamic variables is similar in both groups. Consequently, BP hemodynamic factors alone cannot explain the difference in mortality rates between DHS and non-DHS. The paper by Yashkin et al,⁶ in this issue shows that intensive drug therapy in DHS patients is associated with an increased risk of congestive heart failure, myocardial infarction, and stroke/transient ischemic attack, but a reduction in the risk of mortality. The risk for these CV events and death is decreased significantly by adherence to diabetes management guidelines. The possible signification of these considerations for DHS is the subject of the present commentary.

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